Healthcare Provider Details

I. General information

NPI: 1770800641
Provider Name (Legal Business Name): ELENA N GUTMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELENA N BUKANOVA M.D.

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 DIVISION ST
DERBY CT
06418-1326
US

IV. Provider business mailing address

99 E RIVER DR FL 5
EAST HARTFORD CT
06108-7301
US

V. Phone/Fax

Practice location:
  • Phone: 203-735-7421
  • Fax:
Mailing address:
  • Phone: 860-282-0833
  • Fax: 203-688-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number54465
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: